Clin Exp Otorhinolaryngol.  2015 Mar;8(1):13-19. 10.3342/ceo.2015.8.1.13.

Donor-Site Morbidity Following Minimally Invasive Costal Cartilage Harvest Technique

• Yang HC
• Cho HH
• Jo SY
• Jang CH
• Cho YB

• KMID: 1973482
• DOI: http://doi.org/10.3342/ceo.2015.8.1.13

Abstract

OBJECTIVES
Autologous costal cartilage is a promising alternative for mastoid obliteration. However, donor-site morbidities of the chest wall limit the use of this graft. To address this issue, we have developed a minimally-invasive technique of harvesting costal cartilage and report donor site morbidity associated with the procedure.
METHODS
Donor site morbidities were evaluated for 151 patients who underwent costal cartilage harvest, canal wall down mastoidectomy, and mastoid obliteration. Pain and cosmetic concern were evaluated via visual analogue scale (VAS). Scars were evaluated via the modified Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). Postoperative complications were assessed during the follow-up period.
RESULTS
The mean duration of noticeable pain was 5.3 days post operation. The mean VAS score for pain was 3.0 of 10 on the first day after the operation and gradually declined. At the 6 months post operation, the mean VAS cosmetic score at the costal cartilage harvest site was 0.6 of 10. The mean VSS score was 9.5 out of 10 total, and the mean POSAS score was 23.27 out of 110 total.
CONCLUSION
The minimally-invasive chopped costal cartilage harvest technique resulted in acceptable pain, cosmetic concern, and postoperative complications for most patients. There were no major postoperative complications. Costal cartilage is an acceptable donor for mastoid obliteration in canal wall down mastoidectomy, especially in the context of the extremely low donor site morbidity of the minimally-invasive technique presented in the study.

Keyword

Pain, Postoperative; Pain Measurement; Otologic Surgical Procedures; Cartilage; Tissue and Organ Procurement

MeSH Terms

Cartilage*
Cicatrix
Follow-Up Studies
Humans
Mastoid
Otologic Surgical Procedures
Pain Measurement
Pain, Postoperative
Postoperative Complications
Thoracic Wall
Tissue and Organ Procurement
Tissue Donors
Transplants

Figure

• 

  Fig. 1 Mastoid obliteration with chopped costal cartilage. (A) Costal cartilage was harvested from the 7th rib. Note that perichondrial layers of lower and inferior portions are preserved. (B) Newly devised instruments for costal cartilage harvest. (C) Immediate postoperative photograph of costal cartilage harvest site demonstrates a 1.5-cm incision upon closure. (D) Costal cartilage is prepared by a bone mill. (E) A mastoidectomized cavity before mastoid obliteration. (F) An intraoperative photograph shows a mastoidectomized cavity obliterated with chopped costal cartilage.

• 

  Fig. 2 Age-sex distribution of the study population. Four young women are included in this study.

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  Fig. 3 Visual analogue scale (VAS) pain score of the study patients. The VAS pain score gradually decreased to 0.9 by 180 days after operation. A score of 10 indicates the worst pain imaginable, and a score of 0 indicates no pain. Solid line indicates mean VAS pain score. Error bar indicates standard deviation.

• 

  Fig. 4 Modified Vancouver Scar Scale (VSS) score of the study patients. A VSS score of 10 indicates an excellent donor site, and a score of 0 indicates the worst donor site possible. The VSS score improved over the follow-up period and is relatively close to the highest (optimal) score by 180 days post operation. Solid line indicates mean score. Error bar indicates standard deviation.

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